Preoperative Maximal Oxygen Uptake and Exercise-induced Changes in Pulse Oximetry Predict Early Postoperative Respiratory Complications in Lung Cancer Patients

Abstract

Postoperative respiratory complications often arise in lung cancer patients after lung resection, although these are often difficult to predict. We sought to identify reliable predictors of early-onset postoperative respiratory complications in lung cancer patients who had moderate-to-severe preoperative respiratory impairment. This was a prospective observational study that included 107 consecutive lung cancer patients with forced expiratory volume in 1 s <60% of predicted who were scheduled for thoracotomy and lung resection. Preoperative functional assessments included pulmonary function testing by spirometry, single breath diffusion capacity of lung for carbon monoxide, and cardiopulmonary exercise testing. Risk factors for early-onset postoperative respiratory complications that occurred within 30 days postoperatively were sought from among these pulmonary function testing and cardiopulmonary exercise testing results. By multivariable logistic regression, peak oxygen uptake (V'O2max%; p < 0.001) and the transcutaneous pulse oxygen saturation difference during load exercise (ΔSPO2%; p < 0.001) were independent predictors of postoperative respiratory complications. A receiver operating characteristic curve had an area under the curve of 0.846 for the combination of V'O2max% and ΔSPO2%, while the area under the curve with V'O2max% only was 0.726. From this, the probability of postoperative respiratory complications was [Formula: see text]. Pcomplication ≥ 0.202 for postoperative respiratory complications had a sensitivity of 80.8% and a specificity of 81.5%. For lung cancer patients with forced expiratory volume in 1 s <60% of predicted, in addition to common preoperative tests, V'O2max% and ΔSPO2% may be an aid for predicting early-onset postoperative respiratory complications.